Provider Demographics
NPI:1053587139
Name:BACKUS, CASEY ANN CRISCIONE (MPT)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:ANN CRISCIONE
Last Name:BACKUS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:DEVINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 ALLISON PAGE RD
Mailing Address - Street 2:STE B
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315
Mailing Address - Country:US
Mailing Address - Phone:814-504-8191
Mailing Address - Fax:612-474-1041
Practice Address - Street 1:155 ALLISON PAGE RD STE B
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-8956
Practice Address - Country:US
Practice Address - Phone:910-583-3173
Practice Address - Fax:612-474-1041
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP9992225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2339012Medicare Oscar/Certification